When Death Knocks at the Door

Key points

Awareness of dying may stem from inflammation disrupting the brain's reward system and will to live.

The reward system is the biological engine of motivation, driving us to live by making life feel pleasurable.

Severe illness and aging cause systemic inflammation that impairs the reward system, leading to anhedonia.

Some people seem to understand they are dying a few months or weeks before death through an intuitive sense, even without discussing it. This is particularly remarkable in patients with severe illnesses, such as cancer, or following a major myocardial infarction (MI) or stroke, as well as in older individuals. Studies in hospitals have shown that more than 80 percent of cancer patients who died were aware of their terminal condition. This awareness is nearly 50 p